When assessing a child for signs and symptoms of rheumatic fever which symptoms should the nurse anticipate?

Diagnosis

There's no single test for rheumatic fever. Diagnosis of rheumatic fever is based on medical history, a physical exam and certain test results. Tests for rheumatic fever might include:

• Blood tests. Blood tests can be done to check for signs (markers) of inflammation in the blood. These tests include C-reactive protein and the erythrocyte sedimentation rate.

  Sometimes, a blood test that can detect antibodies to the strep bacteria in the blood is done. The actual bacteria might no longer be detectable in the throat tissues or blood.

• Electrocardiogram (ECG or EKG). This test records the electrical activity of the heart. It can help diagnose irregular heartbeats and can help a health care provider determine if parts of the heart may be enlarged.
• Echocardiogram. Sound waves are used to create pictures of the heart in motion. An echocardiogram shows how blood flows through the heart and heart valves.

Treatment

The goals of treatment for rheumatic fever are to treat the infection, relieve symptoms, control inflammation and prevent the condition from returning.

Treatment for rheumatic fever may include:

• Antibiotics. Penicillin or another antibiotic is typically prescribed to treat the strep bacteria.

  After the first antibiotic treatment is fully finished, a provider typically prescribes another course of antibiotics to prevent recurrence of rheumatic fever. Preventive treatment will likely continue through age 21 or until a child completes a minimum five-year course of treatment, whichever is longer.

  People who have had heart inflammation during rheumatic fever might need to continue preventive antibiotic treatment for 10 years or longer.

• Anti-inflammatory drugs. Aspirin or naproxen (Naprosyn, Naprelan, Anaprox DS) can help reduce inflammation, fever and pain. If symptoms are severe or a child doesn't get better with anti-inflammatory medicines, a corticosteroid might be prescribed. Don't give a child aspirin unless a care provider tells you to do so.
• Antiseizure drugs. Medications such as valproic acid or carbamazepine (Carbatrol, Tegretol, others) may be used to treat severe involuntary movements caused by Sydenham chorea.

Long-term care

Discuss with your care provider what type of follow-up and long-term care your child will need for rheumatic fever.

Heart damage from rheumatic fever, called rheumatic heart disease, might not show up for many years — even decades. Always tell your health care provider about any history of rheumatic fever.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

A health care provider might recommend bed rest for a child with rheumatic fever. Activities may be restricted until inflammation, pain and other symptoms have improved. If inflammation affects the heart, strict bed rest may be recommended for a few weeks to a few months.

Preparing for your appointment

If your child has signs or symptoms of rheumatic fever, you're likely to start by seeing your child's pediatrician. Your child may be referred to a heart specialist (pediatric cardiologist) for some diagnostic tests.

Here's some information to help you get ready for the appointment.

What you can do

Before the appointment, make a list of:

• Your child's symptoms, including any that seem unrelated to your reason for scheduling the appointment and any that have recently been resolved
• Recent illnesses your child has had
• All medications, vitamins or other supplements your child takes or has recently taken, including doses
• Questions to ask the care provider

For rheumatic fever, basic questions to ask the health care provider include:

• What's likely causing my child's symptoms?
• What other conditions could cause these symptoms?
• What tests will my child need?
• What is the best course of action?
• Will rheumatic fever or its treatment affect my child's other health conditions?
• How much do I need to restrict my child's activities?
• Is my child still contagious? For how long?
• What type of follow-up is needed?
• Are there brochures or other printed material that I can have? What websites do you recommend?

In addition to the questions that you've prepared to ask the health care provider, don't hesitate to ask questions during your appointment.

What to expect from your doctor

The health care provider is likely to ask questions, such as:

• When did your child's symptoms begin?
• How have they changed over time?
• Has your child had a cold or flu recently? What were the symptoms?
• Has your child been exposed to strep throat?
• Was your child recently diagnosed with strep throat or scarlet fever?
• If so, did your child take all of the antibiotics as prescribed?

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